Parkinson’s Diseases is a slowly progressive neurodegenerative disorder. It results from dopamine depletion caused by degeneration of dopaminergic nigrostriatal system, leading to a neurotransmitter imbalance between dopamine and acetylecholine in corpus striatum part of the brain. It is expressed in the form of symptoms and signs that include akinesia (loss or impairment of the ability to initiate voluntary movement), tremor, rigidity (inflexibility or stiffness) and unstable posture.
Parkinson’s disease is an extremely disabling neurological disease causing a steep fall in quality of life and enormous patient suffering. However there are various measures that we can take to control the disease, improve the quality of life, ensure patient independence in daily activities and reduce disease related suffering significantly. All these goals can be achieved mainly with the help of 3 strategies, including rehabilitation measures, medical treatment and surgical intervention.
Here in this article we are going to cover rehabilitation measures that can be taken against Parkinson’s Disease. Essence of any Rehabilitation plan is to make a problem list and then address each and every problem accordingly. Here is a list of Rehabilitation interventions that are made to avert various disease related problems in patients of Parkinson’s Disease.
1. Nursing Care:
Following problems of Parkinson’s Disease patients come in the domain of nursing care.
I. Difficulty in Mobility:
A firm bed facilitates changing positions, bed mobility and prevents development of contractures.
II. Postural Hypotension:
Postural hypotension (sudden drop in blood pressure with change in position) is a significant irritant for these patients. It happens due to autonomic dysfunction, which ensues as the disease progresses. It can be managed by careful and gradual change in positions and postures, using compression stockings and abdominal binders that will prevent pooling of blood in lower limb and visceral veins and facilitate its return into arterial circulation. This complication can also be averted with sodium tablets, pseudoephidrine, midodrine and fludrocortisone.
III. Nutrition and Dietetics:
Their nutrition is badly affected by poor chewing and swallowing ability. Oral and pharyngeal movements can be helped with anticholinergic medications just before meals. Balanced, low protein diet under supervision of a nutritionist is most appropriate way to go about diet and nutrition of these patients.
IV. Lung Function:
Baseline vital capacity should be measured and endorsed in record. Incentive spirometry should be incorporated into patient’s routine to prevent atelectasis and pneumonia.
V. Bowel Function:
Lack of gut motility leads to development of constipation, which an be averted with stool softeners, bulk forming agents, cisapride and suppositories.
VI. Bladder Problems:
Parkinson’s Disease affects upper motor neuron hence it leads to development of hyperreflexic bladder. This situation can be managed by anticholinergics that specifically act on bladder’s detrusor muscle such as oxybutynin.
VII. Sexual Dysfunction:
Loss of libido and erectile dysfunction are the main problems faced by Parkinson’s Disease patients. These problems can be addressed according to their presence and severity with the help of sildenafil (viagra) or other disease modifying agents. Other options include intracavernous injections, transurethral suppositories and penile implants.
VIII. Eye Problems:
Lack of blinking in these patients leads to development of dry brittle eyes, which can be addressed with artificial tears.
2. Physical Therapy:
Physical therapy is necessary for Parkinson’s Disease patients in order to prevent and minimize the disease related physical disability. Following are the major physical interventions that are usually made to avert these complications.
I. Relaxation Exercises:
Relaxation exercises can help overcome various disease related problems in this condition.
a. Rotational and Rocking Exercises:
Rigidity is one of the major problems for these patients, which is the mother of many disabilities among them. Rigidity can be overcome with the help of deep breathing, gentle rotational and rocking exercises that relax the rigid groups of muscles. These exercises can be carried out with the help of vestibular ball, rocking chair and cradle.
b. Proprioceptive Neuromuscular Facilitation (PNF):
Freezing phenomenon and inability to initiate a movement or a task can be overcome with the help of proprioceptive neuromuscular facilitation (PNF). This is carried out in the form of passive, active assisted and slightly resisted movements to undo and prevent the unwanted effects of sedentary life in these patients.
c. Jacobson’s Relaxation Technique:
Jacobson’s Relaxation technique involves your focus on sequential contraction and relaxation of muscle groups in your body. This enhances ones own body image and awareness of body sensations.
d. Cognitive Imaging or Guided Imagery:
Cognitive imaging or guided imagery is a technique in which one imagines to picture a person, place or time that promotes the feeling of relaxation. It is useful for getting rid of both mental and physical stress.
e. Meditation for Relaxation:
Meditation for relaxation involves techniques including learning chanting, breathing and mantra.
II. Physical Exercises:
The aim of physical exercises is to maintain cardiopulmonary conditioning, maintain muscle bulk and strength, prevent development of contractures and improve functional capacity.
a. Cardiopulmonary Conditioning:
Cardiopulmonary conditioning is maintained with the help of various exercises including breathing exercises with stress upon both inspiration and expiration phase. Swimming, walking and cycling are particularly important for further progression of the aerobic conditioning. One added advantage of cycling is that it promotes reciprocal movements.
b. Muscle Bulk and Strength:
Muscle bulk and strength can be maintained by resistance exercises especially that of extensors and in particular that of back extensors, glutei and quadriceps.
c. Maintaining Range of Motion and Prevention of Contractures:
As already mentioned rhythmic rotations of neck and trunk not only induce relaxation for mind and body but also prevent development of rigidity induced contractures. Range of motion of all joints with gentle stretching is very useful in maintenance of range of motion and promotes functional independence.
d. Exercises for Functional Independence:
The essence of any rehabilitation plan is functional independence of the patient. Here is an account of measures that one can take to ensure functional independence of a Parkinson’s Disease patient.
These patients should be trained in static skills including sitting balance, and posture control on standing and walking. These skills can be acquired with the help of various exercises and practices including emphasis on whole body movements, sitting balance, bed mobility, transfer training and learning to get out of chair by rocking movements.
Practice of reciprocal movements with stationary bicycle, practicing standing balance in parallel bars with weight shifting and ball throwing are all necessary exercises for acquisition of safe ambulation skills. Alternating movements can be helped with training in rhythmic pattern with the help of auditory cues such as clapping or music. Ambulation and gait training can be carried out by using blocks to force the patients to lift their feet in order to maintain appropriate step length. Further aids for practicing safe walking include encouraging heel-to-toe gait pattern, keeping feet 12 to 15 inches apart, practicing proper arm swing, use of inverted walking stick enhances postural reflexes, colored squares and stripes are good visual aids that can be used as cues during gait training.
Use of assistive devices such as canes, crutches and walkers for gait training and walking in routine should be practiced and encouraged. Weighted walker is usually a very handy gait aid for patients with Parkinson’s Disease. These patients should be taught about energy conservation and body protection with the help of scheduled rest periods and by observing fall prevention measures.
A comprehensive home exercise program should be charted down and patient’s family should be trained in it.